{include file="public/header" /}

<body class="gray-bg">
<div class="wrapper wrapper-content">
    <div class="row">
        <form class="form-horizontal" method="post">
            <div class="col-sm-12">
                <div class="form-group">
                    <label class="col-sm-2 control-label">提现用户ID<span style="color: red;">*</span>：</label>
                    <div class="col-sm-9">
                        <input name="userid" type="text" class="form-control" value="" placeholder="必填 务必保证id输入正确">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-sm-2 control-label">汇付单号<span style="color: red;">*</span>：</label>
                    <div class="col-sm-9">
                        <input name="hfdh" type="text" class="form-control" value="" placeholder="必填 务必填写汇付平台单号">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-sm-2 control-label">提现金额<span style="color: red;">*</span>：</label>
                    <div class="col-sm-9">
                        <input name="money" type="text" class="form-control" value="" placeholder="必填且只能是大于0的数字 单位元">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-sm-2 control-label">说明<span style="color: red;"> *</span>：</label>
                    <div class="col-sm-9">
                        <input name="mnreson" type="text" class="form-control" value="" placeholder="必填，尽量要做到规范统一，方便追查">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-sm-2 control-label">注意事项：</label>
                    <div class="col-sm-9">
                        <p class="tip">务必核对好模拟提现事项的各项信息，正确无误后再提交。</p>
                        <p class="tip">说明必填，尽量要做到规范统一，方便追查。</p>
                    </div>
                </div>
                <style>
                    .tip{
                        line-height: 35px;
                        color: red;
                    }
                </style>
            </div>
    </div>
    </form>
</div>
</div>

{include file="public/footer" /}
{load href="__PLUGINS__iCheck/icheck.min.js"}
{load href="__PLUGINS__iCheck/custom.css"}
<script type="text/javascript">
    $(document).ready(function () {
        $(".i-checks").iCheck({
            checkboxClass: "icheckbox_square-green",
            radioClass: "iradio_square-green",
        })
    });
</script>
{include file="public/bottom" /}
